大剂量骨水泥经皮椎体成形术治疗老年胸腰椎骨折的疗效及其影响因素  

The clinical effect and influencing factors of high-dose bone cement percutaneous vertebroplasty for the treatment of thoracolumbar fractures in the elderly

作　　者：王惠东[1] 姚方超 傅智轶[1] 吴玉杰[1] WANG Hui-dong;YAO Fang-chao;FU Zhi-yi;WU Yu-jie(Department of Orthopedics,Shanghai Ninth People's Hospital,Shanghai Jiaotong University Schoolof Medicine,Shanghai 201900,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海201900

出　　处：《创伤外科杂志》2019年第5期340-345,共6页Journal of Traumatic Surgery

摘　　要：目的探讨大剂量骨水泥经皮椎体成形术(PVP)治疗老年胸腰椎骨折的临床疗效及相关影响因素。方法回顾性分析2015年1月—2017年12月上海交通大学医学院附属第九人民医院骨科行PVP治疗的237例老年胸腰椎骨折患者的临床资料,包括年龄、性别、伤椎节段、骨折压缩程度、骨水泥注射量以及手术前后VAS评分。其中男性61例,女性176例;平均年龄(72.7±9.1)岁。比较患者术前、术后3d的VAS评分,分析各因素与老年胸腰椎骨折PVP术后疗效的相互关系。结果椎体骨折集中在胸腰段,其中T_(12)～L_2共192椎,占总数的81.0%。总体平均骨水泥注射量(6.7±1.5)mL。术前VAS评分7.6±0.9,术后3d 2.8±1.1,术前与术后3d VAS评分差异有统计学意义(P<0.001)。不同的性别(男:5.7±1.0,女:5.6±1.0)、伤椎位置(胸段:5.7±0.9,胸腰段:5.6±1.0,腰段:5.9±0.9)、骨折压缩程度(0型:5.5±1.1,Ⅰ型:5.6±0.9,Ⅱ型:5.8±1.0,Ⅲ型:5.9±0.9)间患者VAS的下降值差异无统计学意义(P>0.05)。年龄(r=0.178)、性别(r=-0.033)、伤椎位置(r=0.102)及压缩程度(r=0.174)与疼痛缓解程度间无显著相关关系(P>0.05),椎体内骨水泥注射量与疼痛缓解程度间有显著相关关系(P<0.001),相关系数r为0.663。骨水泥渗漏组水泥注射量高于无渗漏组(P=0.028),两组间椎体压缩程度及年龄比较差异无统计学意义(P>0.05)。椎体后壁破裂组骨水泥渗漏率高于无破裂组(P=0.004),不同性别、伤椎解剖部位各组间骨水泥渗漏率差异无统计学意义(P>0.05)。结论大剂量骨水泥PVP治疗老年胸腰椎骨质疏松性椎体骨折术后疼痛缓解效果显著。在一定范围内,椎体内骨水泥注射量与疼痛缓解程度间呈正相关。后壁破裂的椎体行PVP手术,应严格控制骨水泥到达的位置与椎体后壁的间距以及骨水泥的推注剂量。Objective To study the clinical effects and related influence factors of treatment of the aged thoracolumbar fracture patients by high-dose bone cement percutaneous vertebroplasty(PVP). Methods Patients in our hospital suffering thoracic and(or) lumbar vertebral fracture treated with PVP between Jan. 2015 and Dec. 2017 were investigated retrospectively,including their age,gender,vertebral segments,degree of compression fracture,injected cement volume,VAS scores before and after operation. There were 61 males and 176 females aged(72.7±9.1) years. VAS scores of the patients before operation and at 3 days after operation were compared,and then the influence factors on VAS scores and the clinical effect of patients with thoracolumbar fracture after PVP were analyzed. Results The fracture vertebraes mainly located in the thoracolumbar segements,in which T12-L2 accounted for 81.0% of the total. The injected cement volume of the 237 vertebraes was(6.7±1.5) mL on average. The average VAS scores of this group of patients were 7.6±0.94 preoperatively,and 2.8±1.1 three days after operation. The difference of VAS scores between preoperation and postoperation was of significance(P<0.01),while among different gender(male: 5.7±1.0,female: 5.6±1.0),vertebral segments(thoracic: 5.7±0.9,thoracolumbar: 5.6 ±1.0,lumbar: 5.9±0.9),degree of compression fracture(type 0: 5.5±1.1,type Ⅰ: 5.6±0.9,type Ⅱ: 5.8±1.0,type Ⅲ: 5.9±0.9) were of no significance(P>0.05). Age(r=0.178),gender(r=-0.033),position of fracture vertebrae(r=0.102) and degree of compression(r=0.174) had no significant correlation with the degree of pain relief(P>0.05). There was a significant correlation between the dose of bone cement injected in the vertebral body and degree of pain relief(P<0.001),and the correlation coefficient was 0.663. The volume of cement injection in bone cement leakage group was higher than that in non-leakage group(P=0.028). There was no significant difference in vertebral compression degree and age between the two groups(P>0.0

关 键 词：胸腰椎骨折 骨质疏松 椎体成形术 骨水泥 老年 

分 类 号：R683.2[医药卫生—骨科学]